Department of Digestive and Endocrine Surgery and Institut de Recherche Contre les Cancers de l'Appareil Digestif, University Hospital of Strasbourg, Strasbourg, France.
Br J Surg. 2011 Nov;98(11):1581-7. doi: 10.1002/bjs.7590. Epub 2011 Jun 28.
Surgery for failed antireflux procedures is technically more demanding than primary fundoplication. The success rate does not equal that of the primary procedures. This retrospective analysis aimed to assess long-term subjective and objective outcomes in patients who underwent laparoscopic surgery for fundoplication failure.
Objective and subjective outcomes were assessed by radiological and endoscopic methods, symptom questionnaire and quality-of-life index at a minimum follow-up of 12 (mean 75·8) months.
The study included 129 consecutive patients who had laparoscopic redo surgery after fundoplication had failed. The most frequent patterns of failure were hiatal herniation (50 patients) and slippage (45). Resolution of the symptoms that led to redo surgery was achieved in 27 of 37 and 11 of 16 patients operated for recurrence and for dysphagia respectively. Objective failure was demonstrated in 16 of 39 patients with herniation and six of 22 with slippage. Seven patients underwent an additional surgical procedure.
Long-term assessment of objective and subjective results after laparoscopic repair for failed fundoplication revealed a high failure rate that increased with the length of follow-up. Unexpected and untreated oesophageal shortening may be responsible for this failure rate.
与初次胃底折叠术相比，抗反流手术失败后的再次手术在技术上要求更高。成功率并不等同于初次手术。本回顾性分析旨在评估腹腔镜胃底折叠术失败后患者的长期主观和客观结局。
通过放射学和内镜方法、症状问卷调查和生活质量指数，在至少 12 个月（平均 75.8 个月）的随访后评估客观和主观结局。
该研究纳入了 129 例因胃底折叠术失败而接受腹腔镜再次手术的连续患者。最常见的失败模式是食管裂孔疝（50 例）和滑动疝（45 例）。因复发和吞咽困难而行再次手术的 37 例和 16 例患者中，分别有 27 例和 11 例患者的症状得到缓解。在 16 例疝和 6 例滑动疝患者中，客观失败得到证实。7 例患者进行了额外的手术。
腹腔镜修复失败的胃底折叠术的长期客观和主观结果评估显示，失败率较高，且随随访时间的延长而增加。未预料到且未治疗的食管缩短可能是导致这种失败率的原因。
